VA building on My HealtheVet successes with mobile apps

Veterans soon will be able to pull up their medical records on their smartphones or tablet computers. The Veterans Affairs Department will launch several mobile applications in the coming months to further the use of telehealth at its facilities across the country.

Dr. Neil Evans, the co-director of Connected Health at the Veterans Health Administration, said two desktop applications through the My HealtheVet portal received such high marks by veterans and their families that VA is making them mobile accessible.

“The Summary of Care app really gives access to the electronic health record data,” Evans said after he spoke recently at the Federal Mobile Computing Summit in Washington, sponsored by MobileGov. “The mobile Blue Button gives access to the same data, but allows the veteran to create a PDF on the fly that they could share with another healthcare provider, for example, that they are seeing outside of VA.”

Evans said VA conducted tests using the beta version of eight mobile applications, and the Summary of Care and Blue Button received the highest marks among users.

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“We know that, at least in our pilot population, veterans wanted to have access on their mobile devices or use these applications to see their electronic health records,” he said. “We’ve learned from our experience that My HealtheVet patients value seeing their personal health data. We’ve also learned that they value it on mobile device through our family caregiver pilot, so it seemed a logical next step to deliver that experience nationally to veterans.”

Evans said he expects both of these apps to be available by mid-fall through an app store run by VA. VA awarded a $9.3 million contract in 2012 to Longview International Technology Solutions to build the app store and set up a mobile device management system.

Value of telemedicine growing

He said veterans need to have username and password log-on credentials to download the apps. VA will provide help to veterans to get authorization.

“VA is creating an app store for all mobile apps. It’s not yet released. It will be released at the time the applications are released,” Evans said. “We have several other mobile applications that will be available to veterans over the coming year-plus. Another example of a feature that is very frequently used on My HealtheVet that is available to veterans right now is online prescription refills. We think delivering that as well in a mobile optimized fashion is important, so a prescription refill app will likely soon be following these first two apps.”

VA has been promoting telemedicine since the 2011-2012 timeframe. But now with the widespread use of smartphones and tablet computers, and with the growing confidence in the security and availability of these apps, the department is focusing more on the creation and oversight of them.

“I’m definitely seeing some of my patients really starting to use their mobile devices as a tool to keep track of their own personal health metrics,” Evans said. “I take care of quite a few diabetics. It used to be that all of my diabetics would bring in in a booklet or scrap of paper with their list of their finger stick blood sugars that they’ve checked. Now, probably 25 percent of the diabetics I take care of bring in their smartphone or a print out of a spread sheet from their finger sticks that they’ve kept. I’m personally seeing a trend in my panel to using technology to keep track of health data, and I think health care can make that easier for patients by delivering applications that let them record their data, but also enhance the relationship with their provider.”

Another benefit of using mobile devices is doctors and nurses can see trends among the data, and use analytics tools to dig deeper into the meaning of the veterans’ information to determine the best path of care.

Evans said VA is running a pilot at 18 medical centers, where it gives healthcare providers mobile devices to keep track of patient data.

Length of stays in hospitals cut by 58 percent

VA’s home telehealth program is a piece to this growing use of technology to better service veterans. Under this effort, VA doctors and nurses use video teleconferencing and other technology to monitor patients who don’t live near a hospital or can’t easily get to one.

Evans said VA served more than 144,000 veterans through the program in fiscal 2013. He said the bulk of the program is designed to keep veterans at home who otherwise would have to be in nursing homes or other care facilities.

“What we see moving forward is that there is an interest in delivering care not just to folks who are dealing with multiple problems who might otherwise end up in a nursing home, but using telehealth applications through mobile devices to help patients manage their more garden variety, for lack of a better term, chronic diseases, hypertension, managing their weight, keeping track of their diabetes or congestive heart failure,” he said. “There’s a lot of potential for using mobility to help patients feel better connected to their health care team during that time when they are not with us at their health care facilities. To use mobile applications, maybe text messaging interventions and other tools to help patients manage their health care on a day-to-day basis, not just when they are coming to see us in the clinic.”

Evans said all of this is about creating connections with patients outside of the traditional office visit.

He said the home telehealth program reduced the number of days veterans spent in the hospital by 58 percent and saves the agency $2,000 a year per patient.

While there is a gold rush of sorts to use mobile apps and devices, VA also is ensuring interoperability and oversight of these efforts.

Evans said VHA is working with VA’s Office of Information and Technology, cybersecurity and subject matter experts, clinicians who understand the user experience and others to create a governance structure for mobile devices and apps.

“If we are creating a mobile platform, we have to make sure that platform has some consistency both for patients and our health care providers. That’s why it’s important to develop shared services, design standards and make sure this is a really well thought-out program,” he said. “Governance has been stood up — we call it the Mobile Applications Governance Board — to really provide a comprehensive look at our mobile portfolio moving forward.”

Evans said VA has a development and production environment for mobile apps. A VA employee or other stakeholder who wants to develop an app must receive approval from the governance board before moving forward.

“It’s really making sure we have all the pieces in place before development starts so the products that come out are part of an integrated system that makes sense for both the veterans and our staff,” he said.

Each week, Defense Reporter Jared Serbu speaks one-on-one and in depth with the people responsible for managing the inner workings of the federal government's largest department, and those who know it best.